The Downside of Risk Management

Even if these risk-management principles are over the top, aren't clients better served by excessive strictness than too much laxity? How does it harm therapy in the long run?

In the first place, an obsession with risk management makes therapists refuse to treat people they could genuinely help, and avoid interventions that are genuinely useful. Some years ago, soon after moving to the small California community where I now live, I got a call from the mother of a child in my daughter's kindergarten class, whose father, a lawyer, was on a basketball league with me. This couple was in a crisis. The woman, already the mother of four children, told me she had an unplanned pregnancy and didn't know what to do. She was inclined toward abortion and her husband, who was pro-life, was against it. For obvious reasons, they had to make a decision within a few days. Could they come see me?

At first, I demurred. I said that, technically, this would constitute a dual relationship and that it would be inadvisable. Her husband then got on the phone and practically yelled at me. "That's why we called you! We know you—we've seen you with your kids, we've heard you lecture, we've seen you on the basketball court and your wife in the bleachers. We chose you because we knew we wanted to work with you." After telling them I'd get back to them, I consulted a philosopher-psychologist friend, Sam Keen—about as far removed from the risk-management zeitgeist as it's possible to be—who was just as annoyed with me as the father had been. "You come from generations of rabbis, who for thousands of years have counseled people they knew. You've spent time sitting with shamans in Africa, who not only know the people they counsel, but know their ancestors, and the spirits of their ancestors. What's your problem, anyway?"

I called the couple back, made an appointment, and they came to see me at my home for the next five evenings as we thrashed out the issues raised by the pregnancy. In the end, we found a way to resolve the dilemma that they could both live with, and which actually strengthened their relationship. This work was a wake-up call for me, making me realize how out of touch the culture of risk management and emotionally-distanced psychoanalytic principles are with the way real human beings live their lives. Somehow, as a profession, we've created this myth that it's better for people who need help to look in the yellow pages or online directory than to turn to somebody whom they may know and trust.